Category Archives: Vaccinations

Our infection prevention and control team has received questions about the measles, mumps and rubella (MMR) vaccine from a number of concerned parents since measles and vaccinations began dominating national news coverage. Here we highlight the number of recommended doses and the times to receive the vaccine.

I want to protect my child. What is the recommendation for the MMR vaccine in Minnesota now?

Children’s Hospitals and Clinics of Minnesota, like most medical centers, follows the guidelines for vaccination as recommended by the Centers for Disease Control and Prevention (CDC) and Minnesota Department of Health (MDH).

Every child should receive two doses of MMR vaccine, with the first dose given between 12 and 15 months of age and second dose between ages 4 and 6 years old. The second dose can be given earlier as long as it comes at least 28 days after the first dose.

If a child will be traveling outside of the U.S., he or she may be given a single dose of MMR if the child is between 6 and 12 months old. However, any dose given before the first birthday will not count towards the regular schedule, and the child still will need the two doses as outlined above.

If an older child is unimmunized and wants to “catch up” on his or her immunization schedule, the child will need two doses of MMR vaccine separated by at least 28 days.

As with all medical decisions, you should discuss your concerns and plan with your clinician. Currently, the CDC is not urging earlier-than-usual vaccinations, even for young children traveling within the U.S. or attending daycare. But as the measles outbreak changes, new guidance may become available. Please continue to check Children’s and CDC websites.

The Minnesota Department of Health reported an international-travel-related measles case on the University of Minnesota campus Jan. 28. To date, there have not been any additional cases in the greater community, and children are not at increased risk.

A few additional points to remember:

Two doses is all that is required, and after that the child is considered immune.

Blood testing for immunity (or titer levels) is not recommended by the CDC.

If adults are unsure of their vaccine status, they should get at least one dose of MMR.

If you have been hesitant to vaccinate your children, take this as a wakeup call. Vaccine-preventable diseases such as measles are active outside of the U.S. and may be just a plane ride away. You can and should protect your children; immunize them.

Joe Kurland, MPH, is a vaccine specialist and infection preventionist at Children’s Hospitals and Clinics of Minnesota.

A rash forms three to five days after other measles symptoms start. (iStock Photo)

Joe Kurland, MPH

Something strange has been happening over the past few years. Infectious diseases are fighting back against the tools that have previously succeeded in protecting us all. In 2000, the U.S. announced that measles had been eliminated from the country. Our tools were so effective and some vaccine-preventable diseases were so rare, that they were all but unknown to a generation of parents and doctors. Sadly, these tools became a victim of their own success.

Measles

Measles is caused by a virus. Sometimes people say “it’s just a virus,” which ignores the fact that some of the most dangerous germs we know are viruses, measles included. It gets into your body when you inhale droplets sneezed or coughed out by someone who’s infected and is considered to be one of the most contagious diseases of which we known, with research showing that, on average, one sick person will infect as many as 18 people who are not protected. Nine out of 10 unimmunized people exposed will get measles because it is that easy to catch. This is partly because measles is an airborne virus; it can survive and infect other people who simply walk through the same room as an infected person. And the infected person doesn’t have to be in the room. The droplets are so small that the air in a room stays infectious for up to two hours after the ill person has left.

OK, measles spreads easily. But is it really that scary? What does it do?

After you’re exposed to measles, it takes between seven and 14 days to develop signs of the infection. The signs include high fever, cough, runny nose and red, watery eyes. You get a rash three to five days after those symptoms start. At first it looks like flat, red spots that show up on your head by your hairline and then spreads like a bucket of rash downwards. It covers your face, neck, chest, belly and finally your arms, legs and feet. The rash may be small, individual, raised, red bumps with flat tops, or they can join into large patches. Four days before the rash shows up, you can spread the virus to others.

For many people, the rash and fever go away after a few days, but for some there are complications. These can vary in severity from mild effects like ear infections and diarrhea to more severe symptoms such as pneumonia and swelling of the brain (encephalitis). Pneumonia is the most common (1 in 20 cases) cause of measles-related death in children, and encephalitis, while less common (1 in 1,000 cases), can cause seizures which may lead to deafness or mental disabilities. For every 1,000 children who get measles, one or two will die from it. Infections in pregnant women may result in premature delivery or a low-birth-weight baby.

You have my attention. What can I do if I’ve never had my shots and may have been exposed?

In the U.S., there are several factors working in a person’s favor:

A modern health system: Clinicians watch for measles and other diseases. If a case is found, they are required, by law, to report it to their local public health departments. The public health experts (epidemiologists) interview the sick person, notify anyone who may have been exposed and work to stop measles in its tracks by having people stay home while potentially contagious.

Effective medication: There are no antiviral medicines available to treat measles. People exposed to the sick person can protect themselves if they act quickly. If the measles vaccine (MMR shot) is given in the first few days after exposure, it can stop the virus from making you ill.

Community immunity: This is perhaps the most effective tool we have. Community immunity (also known as herd immunity) stops a disease outbreak like a firewall by stopping the virus from reaching new hosts. If you surround an infected person with people who can’t get infected with measles — because they are immune, immunized or were previously infected — the virus cannot spread and the outbreak will end. Community immunity is especially important for families where someone is immune-suppressed or who have children younger than 1 year old who are too young to be immunized.

All medical treatments have some risk. But after many studies examined MMR (measles, mumps and rubella) and other vaccines, the final word is the MMR vaccine is safe and rarely causes a severe allergic reaction.

And there is no link between the MMR vaccine and autism spectrum disorders. The association between the two repeatedly has been investigated, and no study has shown results linking the vaccine to the symptoms. In fact, newer research into autism suggests that it’s the result of unusual networking in the fetal brain in the weeks following conception.

What were you saying about our tools being a victim of their own success?

Because the vaccines and immunizations our medical system uses are so effective, the scary, deadly diseases they prevent are now rare. Paralytic polio, babies born with congenital rubella syndrome, tetanus, diphtheria are unknown and forgotten to an entire generation of parents. Because the effects of these diseases were forgotten, the tiny risks for side effects from the vaccines became the focus of concern. Combined with questionable sources in media and on the Internet, fear of vaccines grew. Pockets of underimmunized communities sprung up in cities across the U.S. and provided a foothold for vaccine-preventable diseases, imported from countries with lesser health systems, to resume their toll on a new generation of susceptible children.

But I heard the anti-vaccine community is pretty small and most people follow their pediatricians’ recommendations.

It’s true. Nationally, the number of parents electing to refuse vaccinations is low; however, in some communities, vaccine coverage is less than in war-ravaged Sudan. And this gives the diseases a chance to attack. Measles is so contagious that outbreaks may occur if any more than 5 percent of the community is unvaccinated. Some schools in Oregon and California have reported vaccine rates of 50 percent to 69 percent when anything less than 95 percent vaccinated has great potential for an outbreak.

Vaccines have been so effective that we lost our fear of the diseases they prevented. Amnesia created doubt and hostility towards the utility and need for protection. It is up to parents to protect not only our own children against measles, but in doing so, know that we protect others, too.

Children’s Hospitals and Clinics of Minnesota has seen a large number of influenza cases over the past several weeks, and many children have needed to stay overnight to help treat their symptoms. (iStock photo)

Joe Kurland

Influenza, or “the flu” as his friends call him, is a horrible bug. He wipes you out. He gives you a fever and makes your muscles and joints ache. Your head pounds and you just want to crawl into a warm cave and sleep.

There are many other bugs out there that want to be like the flu. Some of them are bad enough that people even use the term “flu” in their names like “the 24-hour flu” or “stomach flu.” Know this: Real flu does not last only 24 hours, and the real flu does not limit itself to your belly.

If you or a loved one is suffering from sudden vomiting, diarrhea and fever but get better within a day or two, that wasn’t influenza. Those symptoms usually are due to bugs that spread through food. And those bugs love this time of year. With family holiday gatherings, school or office parties, and shared meals, there are lots of chances for the bugs to spread and make people sick.

Some of the infections can come on quickly, such as Staphylococcus aureus infections, that can make you nauseated, vomit or suffer belly cramps and diarrhea in as little as an hour. Other infections can take days. Norovirus, which may show up two days after eating contaminated food, makes you feel miserable with abdominal cramps, vomiting and watery diarrhea. E. coli is another bug that can take as many as eight days or more before you are hit with gas, fever, stomach cramping and even bloody diarrhea.

Fortunately, most people recover quickly from these infections and many don’t need medical care. While you may not feel well enough to eat after infections like those above, it’s important to drink plenty of fluids (water, ginger ale, sports drinks) to prevent dehydration. When you feel well enough to eat, begin slowly and start with easy, bland foods such as toast, oatmeal or crackers. You don’t want to shock your belly with strong flavors, spice or heavy food.

Things are different with the real flu, which is a respiratory illness. Influenza can come on suddenly, with symptoms often including fever, cough, sore throat, runny or stuffy nose, muscle or body aches and fatigue. Some people may experience vomiting and diarrhea, but they are not always present. Influenza infections can be life-threatening and require multiple days in the hospital. Children’s Hospitals and Clinics of Minnesota has seen a large number of influenza cases over the past several weeks, and many children have needed to stay overnight to help treat their symptoms.

And this is why we have an influenza vaccine: it helps prevent you from getting really sick. Sometimes (like this year) the flu changes (mutates) a bit. This can cause you to get real influenza symptoms even though you got your flu vaccine earlier in the season.

Not fair, right?

Well, we may still have the advantage. The vaccine helps train your body to react to the influenza invader and keep the infection under control. You might feel sick for a week and spend some time doing puzzles in your bed (or warm cave), but the vaccine helps keep you out of the hospital. And good news: It’s still not too late to vaccinate against influenza.

Not every illness is the flu. But if you’re feeling sick and are concerned, it’s a good idea to contact us. Whether it’s a wicked seven-day coughing influenza or 24 hours of bathroom misery from a stomach virus, we’re here for you at Children’s.

Joe Kurland is a vaccine specialist and infection preventionist at Children’s Hospitals and Clinics of Minnesota.

Children’s Hospitals and Clinics of Minnesota this month is seeing record numbers of ill children — more than 450 cases, the most ever for this time of year — ranging from 4 weeks to 15 years old, with a fairly common 12 percent admission rate. Many of them have symptoms consistent with influenza, and of those admitted for a stay, 70 percent of the age-eligible kids have been unvaccinated against flu.

While the Internet, the once-nicknamed “information superhighway,” is full of helpful information, it also has its fair share of breakdowns and wrecks. Though it brings us a wealth of knowledge at our fingertips, misinformation also is abundant in today’s 24-hour news cycle. Depending on the topic, the practice can have serious consequences.

This year’s influenza vaccination was designed to protect against up to four strains of the flu (two A strains and two B strains). This month, the Centers for Disease Control and Prevention (CDC) announced that one of the strains of influenza, A H3N2, has drifted, changing itself from what was put in this year’s flu vaccine. It’s like the original plan for the vaccine and the circulating flu strain were to be like identical twins, but now the virus has changed its genetic makeup to present instead like brother and sister. This resulting strain in the vaccine is now about half as protective. However, there are two to three other strains in the vaccine that can help keep you and your family better protected from the flu.

Despite what some vaccination opponents have written and some media have reported, the drifted strain doesn’t mean the flu vaccine doesn’t work, even against A H3N2. It means that the vaccine may not be as effective against the mutated version of A H3N2, though it may lessen the severity of the symptoms from it. The vaccine still protects recipients against the two B strains and other A strain.

Early in each year, in order to manufacture flu vaccine for as many people as possible, the World Health Organization (WHO) makes its recommendations for which strains the flu vaccine should target. This year, according to IFL Science, WHO made its recommendations in February, and A H3N2 was included. The drifted strain was discovered in small numbers at the end of March.

Like with many diseases and illnesses, young children, expecting mothers and the elderly are most susceptible to influenza. Vaccination is important to protect yourself and others. Not everyone is healthy enough to receive the vaccine, which comes in the form of a shot or nasal mist, to protect themselves, so it’s up to everyone to work together to minimize the spread of the potentially fatal disease.

Influenza is a complex, tricky virus that is nearly impossible to predict. From 2013-2014, more than 1,300 Minnesotans were hospitalized with influenza.

And we know that of the 174 kids who died from influenza during the 2012-13 season, 90 percent of them had not been vaccinated. We know that pregnant women are more prone to influenza complications and are a high priority for getting vaccinated, but only half of pregnant women are actually protected.

The flu vaccine isn’t perfect, but it’s still our best defense against what can be a serious infection at any age. It reduces your chance of getting sick. But if you do become sick, it helps reduce the severity.

If not for yourself, vaccinate on behalf of babies who are too young to receive the vaccine (under 6 months of age), women and those with immunity problems or who are undergoing cancer treatment. When you get vaccinated, you protect yourselves and others.

A colleague told me that when her mom was undergoing cancer treatment, she got influenza and died from the infection. My colleague and her entire family were vaccinated that year before flu season and will never miss a chance to protect themselves against the disease that took their loved one.

Patsy Stinchfield, PNP, is the director of infectious disease and prevention at the Children’s Immunization Project at Children’s Hospitals and Clinics of Minnesota.

Children’s will host a screening of “Invisible Threat,” an award-winning documentary about understanding the science of vaccination and the misperceptions that lead parents to delay or decline life-saving immunizations, from 6-8:30 p.m. Thursday at its Minneapolis campus (2525 Chicago Ave. S.).

Parents, health care providers, staff and the public are invited. Flu vaccinations, courtesy of Kohl’s Cares, will be available for 150 people (between 6-7:30 p.m.) and administered by MVNA-qualified nurses. Healthy snacks will be served, and a panel discussion will take place after the film.

The 40-minute independent documentary, produced by high school student filmmakers, has earned praise from more than 50 organizations, including the Centers for Disease Control and Prevention, multiple children’s hospitals, and Every Child By Two, calling the documentary “powerful,” “fast-paced,” “well-balanced” and “impeccably produced.” The event is sponsored by the Minnesota Childhood Immunization Coalition.

Flu season is just around the corner here in Minnesota and across the country. The Kohl’s Cares and Children’s Flu Prevention Project wants to know how you and your family plan to fight the flu this year. You’re invited to participate in the Flu Prevention Photo Challenge to show us how.

The contest runs until Wednesday (Sept. 17). Submit as many photos as you’d like. At the end of the day Wednesday, we’ll choose, at random, five people who each will receive a $50 Kohl’s gift card. Good luck and happy snapping!

Contest rules: Only photos posted by persons 18 years of age or older are eligible.

Social media disclaimer: We welcome and encourage open discussion on Children’s Hospitals and Clinics of Minnesota’s (Children’s) social media sites – including but not limited to our blogs, Facebook, Twitter, YouTube pages and online story-sharing forums – and look forward to any comments, stories and experiences you want to share. Other than the entries Children’s posts ourselves, the opinions and/or views expressed on these sites represent the thoughts of individual bloggers and online communities, and not those necessarily of Children’s or any of our directors, officers, employees, research staff, medical staff or members of our board of directors. All links to other websites found linked from Children’s social media sites are provided as a service to readers, but such linkage does not constitute endorsement of those sites by Children’s, and as such we are not responsible for the content of external websites.

While Children’s makes reasonable efforts to monitor and/or moderate content posted on our social media sites, we do not moderate all comments and cannot always respond in a timely manner to online requests for information. Children’s reserves the sole right to review, edit and/or delete any comments it deems are inappropriate. Comments including, but not limited to, the following may be deleted or edited by Children’s:

Abusive or hurtful comments about a blogger or another participant

Off-topic and redundant comments (this includes promotion of events, groups, pages, Web sites, organizations and programs not related to or affiliated with Children’s)

Personal attacks or defamatory statements or comments about a participant, instead of just criticizing his/her posting, opinion or comments

Comments that violate the privacy of our patients and their families

Please remember that information posted on any of our social media sites shouldn’t be considered medical advice and shouldn’t replace a consultation with a health care professional.

Please be aware that once you post something online, there’s the potential for thousands (or hundreds of thousands) of people to read your words, even years from now. We therefore suggest that you exercise caution when posting medical information on any of our social media sites and that you not disclose personal identifiable information like your location, medical record number, financial information, etc.

By submitting content to any of Children’s social media sites, you understand and acknowledge that this information is available to the public, and that Children’s may use this information for internal and external promotional purposes and fundraising purposes. Please note that other participants may use your posted information beyond the control of Children’s. If you do not wish to have the information you have made available via this site used, published, copied and/or reprinted, please do not post on this page.

Suspected cases of enterovirus D68 infections recently have popped up, with 12 states (Minnesota and Wisconsin are not included to date) contacting the Centers for Disease Control and Prevention for help confirming test samples.

Enteroviruses can be spread by close contact with an infected person who may cough or sneeze on you and by touching objects or surfaces that have the virus on them and then touching your eyes, nose or mouth. (iStock photo / Getty Images)

It is not a mystery virus – we see it every late summer/early fall. What is different is that this particular strain, EV-D68, seems to be causing more intense asthma symptoms, wheezing and respiratory difficulty for a large number of kids at the same time.

Now is as good a time as ever to learn about EV-D68 and enteroviruses in general.

CDC background on enteroviruses

Enteroviruses are common viruses – there are more than 100 types.

Most enterovirus infections in the U.S. occur seasonally during the summer and fall, peaking in September.

It’s estimated that 10 million to 15 million enterovirus infections occur in the U.S. each year.

Most people infected with enteroviruses have no symptoms or only mild symptoms, but some infections can be serious.

Infants, children and teenagers are most likely to get infected with enteroviruses and become sick. Infants and people with weakened immune systems are at risk of the virus worsening into heart or brain infections.

How is enterovirus spread?

“Enteroviruses can be spread by close contact with an infected person who may cough or sneeze on you and by touching objects or surfaces that have the virus on them and then touching your eyes, nose or mouth,” said Patsy Stinchfield, pediatric nurse practitioner and Children’s director of infectious disease and prevention.

Enterovirus D68

Enterovirus D68 is one of many enteroviruses. EV-D68 infections are thought to occur less commonly than infections with other enteroviruses. It first was identified in California in 1962. Compared with other enteroviruses, EV-D68 has been rarely reported in the U.S. in the past 40 years. There have been no known deaths due to the 2014 virus.

What are EV-D68 symptoms?

EV-D68 usually can cause mild to severe respiratory illness; however, the full spectrum of EV-D68 illness is not well-defined. Most people who get infected are infants, children and teens. Most start with common cold symptoms of runny nose and cough. Some, but not all, may also have fever. For more severe cases, difficulty breathing, wheezing or problems catching your breath may occur.

How should I care for my child if I suspect enterovirus D68?

There is no specific treatment for EV-D68 infections. Many infections will be mild and self-limited, requiring only treatment of the symptoms such as increasing fluids and rest or fever-reducing medicine.

Some people with severe respiratory illness caused by EV-D68 may need to be hospitalized and receive supportive therapy such as oxygen and nebulizations. There are no anti-viral medications or vaccines currently available for EV-D68 treatment or prevention.

What do I do if my child has these symptoms?

If your child has these symptoms, Stinchfield says:

If symptoms are mild, such as common cold, parents should do what they normally do with a sick child – increase his or her fluids, rest, keep home from school, give fever- and pain-reducing medicines.

If symptoms are moderate, such as cold symptoms worsening or not getting better within a week, or new wheezing begins, take your child to your clinic.

If at any time your child is having difficulty breathing or you are seeing blue lips or they are gasping for air, take him or her to the closest emergency room.

How do I prevent enterovirus?

There are no vaccines for preventing EV-D68 infections.

Ways to help reduce the risk of getting infected with EV-D68:

Superb hand hygiene is important. Wash hands often with soap and water for 20 seconds, especially after changing diapers.

Avoid touching eyes, nose and mouth with unwashed hands.

Avoid kissing, hugging and sharing cups or eating utensils with people who are sick.

Disinfect frequently touched surfaces, such as toys and doorknobs, especially if someone is sick.

Cover coughs and sneezes.

Stay home if you’re ill.

How do I know if my child has enterovirus D68 or another respiratory illness?

Fall and winter seasons see many different viruses circulating in the community. Some of them that look similar with cough and runny nose include:

Respiratory syncytial virus (RSV) is a respiratory virus that infects the lungs and breathing passages. Most otherwise healthy people recover from RSV infection in one to two weeks. However, infection can be severe in some people, such as infants, young children and older adults. RSV is the most-common cause of bronchiolitis (inflammation of the small airways in the lung) and pneumonia in children younger than 1 year of age in the U.S. RSV is more often being recognized as an important cause of respiratory illness in older adults.

Influenza (flu) is a contagious respiratory illness caused by influenza viruses. It can cause mild to severe illness. Serious outcomes of flu infection can result in hospitalization or death. Some people, such as older people, young children, and people with certain health conditions, are at high risk for serious flu complications. The best way to prevent the flu is by getting vaccinated each year – Children’s is hosting vaccination clinics at Kohl’s stores around the Twin Cities metro area.

Thank you to everyone who joined us for #MNvaxchat on Monday night. More than 75 participants from across the U.S. engaged in a conversation about vaccinations with Patsy Stinchfield, PNP, Children’s director of infectious disease and prevention, and John W. Baker, MD, a pediatrician at Metropolitan Pediatric Specialists in Burnsville.

The informative hour-long chat, hosted by Children’s and Twin Cities Moms Blog, respectfully covered more than a dozen unique, well-researched topics with a highly engaged audience of parents and advocates.

The recipient of the $50 Target gift card is Linsey Rippy. Congratulations, Linsey!

We look forward to hosting more Twitter chats on a variety of health topics!

Jimmy Bellamy is the social media specialist at Children’s Hospitals and Clinics of Minnesota.

August is National Immunization Awareness Month, and Minnesota’s new immunization requirements take effect Sept. 1. With that and back-to-school mode under way, we’ll be co-hosting a Twitter chat with our friends at Twin Cities Moms Blog.

Join us for the live chat, using #MNvaxchat from 8-9 p.m. Monday, that will feature Patsy Stinchfield, PNP, director of Infection Prevention and Control and the Children’s Immunization Project at Children’s Hospitals and Clinics of Minnesota. Children’s and Twin Cities Moms Blog will be there, too. Participants who use #MNvaxchat in tweets during the live chat qualify for a chance to win a $50 Target gift card.

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